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Clinical Documentation Integrity (CDI) Specialist - Remote

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Guidehouse

2mo ago

  • Job
    Full-time
    Junior & Mid Level
  • Science
    Healthcare
  • Washington

AI generated summary

  • You must have RN, MD, or MBBS, plus 2-4 years in acute care coding or CDI. Familiarity with encoder, DRG, and current coding guidelines is essential.
  • You will review medical records, clarify documentation, prepare compliant queries, assign diagnoses and DRGs, track responses, maintain productivity, collaborate with coding teams, and uphold HIPAA compliance.

Requirements

  • At least one of the following: RN, MD, or MD Equivalent (MBBS)
  • At least 2-4 years acute care inpatient hospital coding or CDI experience
  • Familiarity with encoder and DRG assignment
  • Maintain current working knowledge of official coding guidelines and coding clinics.

Responsibilities

  • Conducts comprehensive initial and follow-up concurrent reviews of medical records for assigned patients in the time frame, frequency and prioritization as defined for the CDI team
  • Identifies opportunities to clarify incomplete or conflicting documentation and/or to validate diagnosis in the medical record.
  • Understands the guiding principles of clinical validation and writing a compliant query.
  • Prepares a compliant written query for responsible treating physician, following the most current ACDIS/AHMIA Guidelines to Achieving a Compliant Query Process
  • Identifies principal diagnosis options, secondary diagnoses and significant procedures in order to assign working MS-DRG.
  • Establishes a working DRG and updates DRG based on record documentation during concurrent reviews to reflect current expected Length of Stay as appropriate
  • Utilizes the appropriate UAB query template and follows 2022 ACDIS/AHIMA Guidelines to Achieving a Compliant Query Process
  • Ensures relevant and/or approved clinical indicators specific to the patient and the clinical record are cited on the query template.
  • Choices provided on the query must reflect reasonable conclusions specific to the patient and the clinical record
  • Demonstrates knowledge of Patient Safety Indicator’s (PSI’s), Hospital Acquired Conditions (HAC’s), Severity of Illness & Risk of Mortality (SOI/ROM) as well as present on admission status
  • Ability to appropriately apply and use hospital approved clinical indicators for specified diagnoses
  • Ability to follow hospital specific procedures and policies with regards to documentation requirements, query escalation, DRG reconciliation and other duties.
  • Tracks physician query response documented in the medical record.
  • Maintains productivity and established performance benchmarks for quality
  • Ensures competency in use of CDI application to process and prioritize daily work lists, capture results of record reviews, track queries and query responses.
  • Enters all required data into CDI application and/or other systems to enable coders and CDI/Coding auditors to determine disposition of concurrent queries in order to assign the final MS-DRG as well as SOI and ROM.
  • Ensures competency in use of electronic coding references to code and assign working MS-DRG along with, SOI and ROM; as well as reference related Official Coding Guidelines and Coding Clinic for accurate code assignment
  • Collaborates with Coding team on any questions related to ICD-10 coding and/or MS-DRG assignment, involved in the preparation of concurrent and/or retrospective queries.
  • Participates in DRG reconciliation process in a collaborative, timely, and thorough manner with coders
  • Participates in departmental and hospital committees, assigned task forces, including service line assignment meetings as requested
  • Contributes to a positive and collaborative working environment
  • Comply with HIPAA and code of conduct policies

FAQs

Do we support remote work?

Yes, this position is fully remote.

What qualifications are required for this job?

Candidates must have at least one of the following: RN, MD, or MD Equivalent (MBBS), along with 2-4 years of acute care inpatient hospital coding or CDI experience.

What certifications would be beneficial for this role?

CCDS or CDIP certifications are preferred for this position.

What is the salary range for this position?

The annual salary range for this position is $61,000.00 to $101,000.00, depending on various factors including experience and qualifications.

What are the essential job functions of a CDI Specialist?

Essential job functions include conducting medical record reviews, identifying documentation opportunities, preparing compliant queries for physicians, and collaborating with coding teams.

Is travel required for this position?

No, travel is not required for this position.

What benefits does Guidehouse offer?

Guidehouse offers a comprehensive benefits package including medical, dental, vision insurance, paid holidays, parental leave, a 401(k) retirement plan, tuition reimbursement, and more.

How important are communication skills for this role?

Effective verbal and written communication skills are essential for interacting directly with physicians and other clinicians in a professional manner.

Is experience with coding software necessary?

Yes, strong typing and computer skills as well as proficiency with EHR systems, CDI software systems, and encoders are necessary.

Will I have the opportunity to work independently?

Yes, the role requires a team player who can also work independently with minimal supervision.

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Guidehouse

Consulting
Industry
10,001+
Employees
2018
Founded Year

Mission & Purpose

Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies.

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